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759 Test 1
Skin, Hematology, DM
| Term | Definition |
|---|---|
| Diabetes Symptoms | polyuria, polydipsia, weight loss, blurred vision, fatigue, irritability, extreme hunger, recurring skin, gum and bladder infections, slow healing cuts or bruises, loss of feeling or tingling in the feet |
| Acute diabetic complications | hyperglycemia with ketoacidosis, non ketonic hyperosmolar syndrome |
| Chronic diabetic complications | Retinopathy Nephropathy Peripheral/ autonomic neuropathy |
| Type 1 DM C peptide levels | low or undetectable |
| Hx of gestational DM screening | postpartum 6-12wks then every 3 years |
| Prediabetes and Type 2 screening | any age with obesity that have one or more risk factors Asymptomatic without risk factors screen at age 35 If normal repeat testing minimally every 3 years If AIC > 5.7 (prediabetes) test yearly |
| Risk factors for pre dm and DM | FH of DM PMH of gestational DM or >9lbs delivery HTN Hyperlipidemia PCOS CVD Acanthosis Nigricans |
| Pre diabetes Diagnosis | Impaired fasting glucose 100-125mg/dl Impaired glucose tolerance : OGTT >140 and <200 A1C: 5.7 to 6.4 |
| Children and adolescent Screening for DM | Test if overweight BMI >85% for age/sex possitive FH of type 2 in first or second degree relative Race and ethnicity ( AA,NA, PI, latino) Signs of insulin resistance or conditions associated with insulin resistance Maternal hx of DM or GDM during ch |
| Children/ Adolescent type 2 DM screening age | 10 years or the onset of puberty if puberty occurs at a younger age Repeat every 3 years if normal |
| Diabetes Diagnosis | A1C >6.5 Fasting Plasma glucose >126 2-h OGTT plasma glucose >200 symptoms of hyperglycemia and a random plasma glucose >200 |
| A1C Monitoring | A1C 2X a year if stable A1C every 3 months if unstable Goal for non pregnant adults <7%- decreases risk of micro/macro vascular complications and neuropathy Adjust goals for elderly and children (<8.0-8.5) |
| ADA diabetic control goals | FBG: 70-130 Pre-prandial- 70-130 Post- Prandial - <180 Bedtime: 90-150 A1C: <7 |
| Immunizations | Annual influenza Pneumococcal: 1 time revaccination >64 yrs if vaccinated before 65 Covid booster RSV >60 Zoster with 2 doses shigrix age >50 |
| Blood Pressure management DM | Goal <130/80 Treat with ACE or ARB (renal protective) Uncontrolled HTN= macro/microvascular complications neuropathy and retinopathy |
| Lipid Management DM | Aggressive lipid lowering LDL <70 for ages 40-75 with ASCVD risk factors HDL >40 men and > 50 women Triglycerides <150 All diabetics need to be on a statin regardless of lipid pannel |
| Nephropathy Recommendations | Annual urine albumin excretion (type 1 with DM >5 yrs, all type 2 starting at time of diagnosis) Serum Creatinine annually for all DM adults **Treat all non pregnant patients with elevated microalbumin either with an ACE or ARB** |
| Retinopathy Recommendations | Type 1: adults and children >10 - initial dilated eye exam and comprehensive eye exam within 5 years of onset Type 2: initial dilated eye exam and comprehensive eye exam soon after diagnosis **Annual Dilated exams*** |
| Neuropathy Reccomendations | Screen for distal polyneuropathy at diagnosis and at least annually Annual Foot exams: inspect, pulses, monofilament testing plus 1 of either vibration, pinprick sensation, ankle reflexes or vibration preception Vibratory sensation is ussuallyy the 1st |
| Children and Adolescents Type 1 DM microalbuminuria | Annual screening for @ age 10 if diabetic X 5 years Confirmed if persistently elevated on 2 additional urine specimens ****Treat with ACE inhibitor*** |
| Children and Adolescents Type 1 DM HTN | Diet and excersise to control weight and increase activity If no change in 6-12 months treat with ACE- inhibitor |
| Children and adolescent Lipids screening | >2 yrs old at time of diagnosis (after glucose control is established) if + FH hypercholesteremia >240 or CVD prior to 55 or if unknown FH If FH not significant screen at puberty (10 yrs) |
| Children and adolescent Lipids management | Statin therapy can be added after age 10 who have LDL >160 or LDL >130 with 1 or more risk factors LDL goal <100 |
| Celiac Disease | Screen soon after diagnosis Repeat if growth delay, weight loss or GI symptoms If antibodies positive refer to GI |
| Hypothyroidism | Screen after glucose control established If normal screen ever 1-2 years |
| Key Reccomendations DM | Aggressive lipid lowering with high intensity statins ezetimibe & PCSK9 inhibitors LDL<70 for ages 40-75 with ASCVD risk factors LDL <55 if clinical ASCVD Screen for NAFLD, PAD, SA, and depression |
| Reduction in CKD progression | SGLT2 inhibitors, Kerendia (finerenone) increased monitoring and referrals |
| Sulfonylureas | Glipizide, Glyburide, Glimepiride Increases the secretion, absorption and glycogenesis Adverse effects: hypoglycemia Effect of weight gain |
| Binuanides | Metformin Decreases hepatic glucose production and increases insulin sensitivity in adjunct with diet and exercise in type 2 Monotherapy or with sulfonylurea or other agents and insulin in adults Side Effect: Diarrhea ***B12 deficiency**** |
| Pharm treatment combos DM2 | Sulfonylurea and biguanide Glucovance (Glyburide & Metformin)- take with meals Janumet- DPP4 inhibitor and Metformin- take with meals Must have pancreatic function to work |
| Thiazonlidiones | Actos ( Pioglitazone) Can cause cardiac problems, weight gain and edema |
| Dipeptidyl Peptidase 4 inhibitors | Sitagliptin (Januvia) - enhances incretin system to act on alpha and beta cells. Increases insulin and decreases glucagons Can be combined with metformin - Janumet Weight neutral |
| DPP4 inhibitors cont | Onglyza (Saxagliptin) Tradjenta (Linagliptin)- potentate by CYP3A4/5 inhibitors Can interfere with CYP3A4 becareful prescribing agents that interfere with this such as ketoconazole Used in adjunct with Metformin |
| GLP1 Receptor Agonists | Ozempic, Trulicity Stimulate insulin secretion and decreases glucagon levels Inject once daily independent of meals Side effects: wt loss and nausea Can lower risk of death from CVD |
| GLP1 Receptor Agonists oral agent | Rybelsus (Semaglutide) Starting dose is 3mg daily for 30 days then increase to 7 or 14 mg achieve glycemic control Must be taken on empty stomach and 30 minutes before eating |
| Sodium Glucose Co-transporter 2 inhibitor | Invokana Jardiance Farxiga Contraindications- Severe renal impairment SE: GI upset and fungal infections, wt loss Often used alongside metformin |
| GIP &GLP 1 | Tirzepatide (Mounjaro) First in class GIP& GLP1 receptor agonist Enhances first and second phase insulin secretion Reverses Glucagon levels Decreases fasting and postprandial glucose Decreases food intake and weight SQ weekly 2.5mg start-15mg |
| Rapid acting insulin | Humalog (Lispro) onset: 15-30min, peak 30-90m, duration:4-6h Aspart (novolog): onset: 15-30min, peak 30-90m, duration:4-6h |
| Short acting Insulin | Regular Onset- 30-60min peak: 2-3h duration: 8-10h |
| Intermediate Acting insulin | NPH (humulin N and novalin N) 70/30 Lente (Humulin L) Onset: 1-2h, Peak: 4-12 h, Duration: 18-24h |
| Premixed Intermediate and rapid mixtures | NPH with regular insulin (50/50, 70/30, 70/25) Humalog and Humulin - Novulin 50/50 More long acting coverage 14-24 hours |
| Long Acting Insulin | Levemir( onset 2-4h, no peak, duration 20-24h) Lantus (onset 2-4h, no peak, 24 h duration) Called Basal insulins Starting dose 10 units |
| Insulin Dosing Type 1&2 Adults | 0.5-1u/kg/day |
| Insulin Dosing Type 1&2 Adolescents | 1.2-1.4 u/kg Need higher amount because they are growing |
| Insulin Dosing Type 1&2 Pre-Adolescents | 0.7-0.8 u/kg |
| Insulin Dosing Type 1&2 Older adults | 0.5/u/kg/day |
| Elevated Blood Glucose before breakfast | Increase pre-dinner or pre-bed intermediate or long acting insulin |
| Elevated blood glucose after breakfast | increase pre-breakfast short or rapid insulin |
| Elevated blood glucose before evening meal | increase pre-breakfast intermediate acting insulin or increase dose pre-lunch of short or rapid acting insulin if on basal bolus regimen |
| Elevated blood glucose after evening meal | increase pre-evening meal short or rapid acting insulin |
| Diabetics are More prone to what autoimmune diseases | Hashimotos thyroiditis (most common), addisons disease, celiac, vitiligo, autoimmune hepatitis, pernicious anemia, graves, myasthenia gravis |
| Treatment Goals Type 1 | Insulin to achieve near normal BS Diet sufficient for growth FSBS monitoring QID or more HgbA1C quarterly to assess glycemic control Prevent short and long term complications |
| Children under 7 yrs A1C goal | 7.5% |
| HGA1C | normal <5.6 At risk: 5.7-6.4 Pt w/ diabetes: >6.5 Reflects average BS level over 2-3 months Measure every 3 months |
| 75/25 Humulin | 75% NPH, 25% Lispro Eat Immediately |
| 70/30 Humulin | 70% NPH 30% Regular wait 20 minutes prior to eating |
| 70/30 Novolog | 70% NPH 30% Novolog can eat immediately |
| 70/30 Novalin | wait 20 minutes to eat |
| Carbohydrate Bolus | taken with food or beverage with carbohydrates is ingested based on insulin to carbohydrate ratio I:C |
| Correction Bolus | taken to correct high blood sugar out of target range based on insulin sensitivity factor or drop factor |
| Total meal bolus | depends on amount of carbs and current BG- if less than target may subtract or give snack. If greater than target may give insulin and may subtract insulin on board from prior bolus |
| Lipohypertrophy | fat under skin that accumulates due to repeated injections |
| Lipodystrophy | indentation due to repeated injections at one site |
| Pump Bump | warm, tender area at site of current or prior insertion could lead to abscess or cellulitis |
| Treatment of hyperglycemia | BS 240 or < or if patient is ill or vomiting Check urine for keytones if mod/large: will need extra humalog coverage If small/neg: push SF fluids, may need short acting insulin coverage |
| DKA | Complex metabolic state of hyperglycemia, acidosis, and ketosis resulting from untreated absolute insulin or relative insulin deficiency Can die from cerebral edema |
| DKA labs | PH <7.3 Bicarb <18 BG >250 Refer for hospitalization |
| DKA Symptoms | Kussmauls Respirations (hyperventilation, tachypnea) Tachycardia, poor perfusions, lethargy, weakness, fever, acetone smell on breath |
Created by:
elynnburke2